Provider Demographics
NPI:1225069982
Name:SIDAWY, EMIL NICHOLAS (PHARMD, MS)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:NICHOLAS
Last Name:SIDAWY
Suffix:
Gender:M
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9404 LOST TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2093
Mailing Address - Country:US
Mailing Address - Phone:301-765-8978
Mailing Address - Fax:
Practice Address - Street 1:9404 LOST TRAIL WAY
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2093
Practice Address - Country:US
Practice Address - Phone:301-765-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist